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The administration, hurrying to cement its social agenda in place
before leaving town, adopted a most meddlesome, dangerous rule at
Health and Human Services.

The proposed "conscience" rule is scheduled to take effect on
January 19, 2009. Congress and President-elect Obama have separate and
distinct options to prevent implementation of this rule.

Under the guise of protecting those with strong religious and moral
convictions from workplace "discrimination," the rule encourages
zealous, sanctimonious healthcare workers to act out their convictions
at the expense of the patients they are supposed to serve.

Most commentary on this rule focuses on impending damage to
reproductive services and access to abortion and contraception. But at Compassion & Choices,
our concerns center on end-of-life care, especially the palliative care
measures that rescue patients from unbearable agony. This ill-conceived
rule will surely obstruct and delay good care in many instances,
increasing the suffering of dying patients and their loved ones.

The pertinent section, 88.4 d 2,
bars health care institutions and employers from requiring "…any
individual to perform or assist in the performance of any part of a
health service program…" if it would offend his or her religious
beliefs or moral convictions. Health care workers cannot be fired or
disciplined for refusing to do their job based on their beliefs.
Absolute job protection extends to physicians, nurses, pharmacists,
respiratory therapists, IV technicians — apparently even cleaning and
maintenance staff.

Compassion & Choices submitted a letter stating its concerns
during the mandatory comment period. The comments went unheeded and the
final rule stands virtually unchanged from the one proposed.

Anyone who works in end-of-life care or health care policy, and
anyone who has cared for a loved one during the final stages of
terminal illness, knows we already have a problem, even without this
rule. Too much pain and suffering goes untreated or under-treated and
too many people die in agony. The Compassion & Choices legal team
has helped raise the standard of care by sponsoring helpful bills and
successfully challenging under-treated pain as a form of elder abuse, but the need for improvement remains great.

Now comes a federal rule encouraging workers to exercise their
idiosyncratic convictions at the expense of patient care. Employees
who, for example, might exalt suffering, or disapprove of discontinuing
feeding tubes or respiratory support have license under this rule to
refuse to deliver or support any treatment or procedure. They can do
this without prior notice or the courtesy of providing substitute
staff. End-of-life suffering often presents as a medical emergency.
Precipitous refusal could leave patients in agonizing pain or gasping
for air while others scramble to fill the refuser’s duties.

Our staff and volunteers deliver information and support to clients
and their families throughout the nation, and we hear many excuses for
under-treating end-of-life symptoms. Some are profound, like doctors
genuinely afraid to prescribe rapidly escalating doses of morphine and
other opioids that are often necessary to stay ahead of pain. They fear
a whistle blower might alert drug enforcement agents, initiating a
federal prosecution. Some excuses are downright silly, like the
determination to keep a dying person from becoming "an addict" in their
last days.

But the most wretched excuse for under-treating pain and other
agonies comes from pious, sanctimonious zealots. I recall one doctor
who told a client’s family not to expect total relief because "we all
have to suffer some" in dying.

This particular conviction finds support in the Ethical and Religious Directives for Catholic Healthcare, (ERDs)
which guide the behavior of every Catholic institution and healthcare
worker. ERD #61 instructs that dying patients whose pain,
breathlessness or other agony cannot be relieved by usual methods
should receive instruction in "the Christian understanding of
redemptive suffering."

Fortunately, presiding bishops and Catholic hospitals enforcing the
ERDs generally lean toward mercy and compassion in their
interpretation. But the existence of this rule threatens that mercy
with a new army of vigilantes authorized to further their patients’
redemption by slowing or withholding the medication that would relieve
their pain. If discovered, such sanctimonious saboteurs could not be
disciplined, fired, or even re-assigned, under this rule.

Most vulnerable is the compassionate end-of-life treatment known
variously as "terminal sedation" "palliative sedation" or "total
sedation." Conditions like bone metastasis or bowel obstruction can
cause pain so virulent it is relieved only by placing the patient in a
coma with strong sedatives and maintaining the coma until death. The authors at HHS apparently had terminal sedation (TS) in their sites in the draft proposal.
They revealed their disapproval when they erroneously referred to it as
"euthanasia," citing a 2007 New England Journal of Medicine report that
17% of physicians object to TS on moral grounds. While the final rule
did not refer to this pre-decisional citation, nothing suggests the
department abandoned TS as a target.

Pious believers stress conscious mental preparedness for death and
are reluctant to cause unconsciousness unless they deem it absolutely
necessary. (See ERD #61) Unaware of this, we were initially surprised
when Christian medical societies and Catholic hospitals fought a
California bill to inform patients about palliative sedation. The Right to Know End-of-Life Options Act (R2K) insures
patients will receive information about this treatment option when they
ask. Right-to-life publications reacted to R2K with contempt and
hysteria. They called this simple information law "nurse assisted
suicide," "euthanasia flirtation" and "suicide promoting."

Such vehement objection suggests right-to-life activists may
sabotage terminal sedation as a treatment option, with job security
guaranteed under the protections of the new rule.

Compassion & Choices has worked for years to raise the standard
of care for end-of-life pain and symptom management. We’ve litigated
under-treatment and sponsored bills to establish a right to pain care
and mandate pain care education as a condition of physician licensure.
It dismays us to know policies, laws and education efforts could fall
victim to healthcare workers encouraged to impose their personal
religious convictions on dying patients in every state.

Revocation of this rule should be high on the Obama administration’s
immediate agenda. If procedural requirements slow the revocation
process, Congress should act immediately to prevent the rule from
taking effect. Decency and mercy demand swift action.

]]>http://rhrealitycheck.org/article/2009/01/12/hhs-conscience-rule-what-about-endoflife-pain-care/feed/3HHS “Provider Conscience” Rule Puts Public Health in Dangerhttp://rhrealitycheck.org/article/2008/12/24/hhs-provider-conscience-rule-puts-public-health-danger/?utm_source=rss&utm_medium=rss&utm_campaign=hhs-provider-conscience-rule-puts-public-health-danger
http://rhrealitycheck.org/article/2008/12/24/hhs-provider-conscience-rule-puts-public-health-danger/#commentsWed, 24 Dec 2008 07:00:00 +0000The right of conscience is a time-honored value in our society. But it is not only health providers who have rights; so do patients.

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As expected, the Bush administration finalized its proposed "provider conscience" rule last week. Despite opposition from leading medical groups like the American Medical Association, the American College of Obstetricians and Gynecologists, and the American Hospital Association; from Senators, House members, and state attorneys general; from officials at the Equal Employment Opportunity Commission; and from over 200,000 individual commentators, the Health and Human Services Department pushed through a rule that expands the right of health care workers to refuse to provide medical care, counseling, referrals, and even information to an unprecedented level.

The rule is pernicious in many ways. It allows all employees, and even volunteers, of most institutions receiving HHS dollars to deny access to a wide variety of medical services. The rule ostensibly protects only employees who object to abortion and sterilization, but it is written so broadly that it could also apply to contraception, fertility treatments, HIV/AIDS services, gender reassignment, end-of-life care, or any other medical practice to which someone might have a personal moral (not even religious) objection.

This rule is not "just a woman’s issue," though the more than 17 million women who depend on our public health system and who are disproportionately low-income and women of color will certainly bear the largest brunt of this politically-motivated regulation. The rule also provides a striking example of how the stigmatization of one medical service-specifically, abortion-can quickly creep into other areas and erode well-established medical standards of care. Allowing medical services to be ranked on a scale of moral superiority is a public health problem.

The right of conscience is an important and time-honored value in our society and one that should not be tread upon lightly. But it is not only health providers who have rights; so do patients. Standards of care and codes of conduct exist to balance the rights of them both. Instead of pitting the rights of providers and patients against one another, perhaps there are a few tenets upon which we as a society can agree:

Withholding relevant, medical information from patients is never good medical practice nor ethical;

Providers who are unwilling to provide certain services must give their patients timely notice of their refusal to do so and must refer those patients to a provider who can supply the needed health care.

Despite the fact that professional medical associations have consistently endorsed these precepts, the new HHS rule ignores all three of these basic yet essential codes. Fortunately, it is likely that the new administration and the new Congress will work to reverse this rule as quickly as possible. But this debate will not end with the demise of this rule, and we must not countenance some very dangerous concepts that have been advanced in support of the rule.

Requiring a health care provider to do his or her job is not discrimination. Employers are required to accommodate an employee’s religious beliefs when doing so does not present an undue hardship on the employer. However, refusal or withdrawal of health care in a manner that neglects a patient’s needs is an undue hardship and should not be entitled to accommodation.

Providing a referral for a service is not morally equivalent to providing that service yourself. There are varying degrees to which one’s conscience may be burdened by certain actions. Supplying information about where to find appropriate medical care ought not to tax one’s conscience to the same extent as performing a procedure or dispensing medication. Moral beliefs exist along a continuum and the protections afforded for such beliefs must be proportionate as well.

A refusal to provide care can harm patients. In our current health care system, we face a shortage of primary care physicians, a nursing shortage, a vast population of uninsured and underinsured patients, hospitals that cannot afford to stay open, and rural communities with few health care resources like clinics and pharmacies. Health care providers should not assume that just because they say no, a patient will be able to find another provider who will say yes who is also affordable and accessible.

The so-called "provider conscience" rule disrupts the careful balance established by medical codes of conduct and standards of care, placing the health, well-being, and dignity of patients at risk. We must work to ensure the proper balance is restored quickly, so that we can continue to protect the right of conscience while also protecting access to all health care services for every patient who needs them.

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In the 127-page rule released yesterday, Health and Human Services Secretary Mike Leavitt paints a picture of discrimination and retribution in the medical world. He portrays this new regulation as a much-needed recourse for medical providers living in fear. He argues that too few doctors and nurses know that federal law already protects their jobs if they abstain from providing abortions or sterilizations based on their personal beliefs. He imagines that anti-choice physicians are forced by their pro-choice colleagues to stifle their objections rather than risking professional suicide by speaking up.

Secretary Leavitt outright refuses to offer any evidence to support these allegations; no one knows where this scenario plays out or how often. But I can say that it bears no relation to my experiences as an ob/gyn in New York City, nor does it match what my peers around the country tell me about their jobs and hospitals.

And the hundreds of physicians who submitted public comments against the regulation did not share Secretary Leavitt’s view of their workplaces, either. In fact, many hospitals in the United States do not provide abortions at all, and they do not train their residents in pregnancy termination, either, not even to prepare them for emergencies.

If Secretary Leavitt had visited the hospital where I practice, he would have found that every employee knows their rights. Some will not assist women undergoing abortion. They step away from these procedures without penalty or censure. Indeed, their colleagues take on more work to protect their right to refuse.

At my hospital, Secretary Leavitt would have met a few residents who opted out of the day in their rotation when I teach abortion procedures (the majority participate). He would have seen that this did not affect their grades, their recommendations, or any aspect of their future careers.

Secretary Leavitt would have talked to the anesthesiologists on staff, some of whom prefer not to participate in abortions. He would have heard about the ways we balance the schedules to accommodate these physicians and their beliefs.

In the bookkeeping office, Secretary Leavitt would have talked to a clerk who refuses to process state Medicaid forms for abortion patients — and another clerk who does this work for her. No harm done.

Even in medical crises, we honor employees’ consciences. I wish Secretary Leavitt had been at the hospital the day that my patient Melissa* started to hemorrhage.

Because she was 16 weeks pregnant and already ill, Melissa was in a bed on the labor and delivery floor. She began to bleed. Her only treatment option was abortion; she agreed to end her pregnancy.

We could have moved her into the empty operating room across the hall for her dilation and evacuation (D&E) abortion. We did not. Instead, we put her on a gurney and took her, in pain and bleeding, on a 15-minute ride through the hospital’s labyrinthine corridors to another operating room.

Why not use the room seconds away from Melissa’s bed? Melissa’s nurse said, "I’m not going to help you with an abortion." She refused to be in the operating room, even though she would perform no part of the procedure herself. We had two surgeons at Melissa’s side ready to go, but still we moved Melissa to a part of the hospital staffed by a nurse who did not object to abortion.

Melissa survived the balancing act between her health and her nurse’s beliefs. As they are written, the laws on medical workers’ consciences sometimes put us in tricky situations, but we follow them while keeping our patients healthy. Now Secretary Leavitt has put fresh obstacles between women and the treatments they need to stay well. His regulation expands the scope of current laws, extending refusal to many more medical services and letting healthcare employees withhold even information about patients’ options.

Physicians like me understand that Secretary Leavitt’s rule is, at best, a waste of time and money for the 571,947 hospitals and other healthcare providers to which it applies. At worst, the regulation will cause real harm to women and families.

We look to Tom Daschle, the incoming Secretary of Health and Human Services, and President-elect Obama to reverse Secretary Leavitt’s rule. None of us can afford the damage it will do, both to the practice of medicine and the lives of our patients.

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Very little about the Bush administration could surprise me anymore,
but I was completely disheartened when — despite the written
opposition from more than 200,000 Americans, 150 members of Congress, a
bipartisan coalition of governors and attorneys general, the American
Medical Association, and women’s health organizations like Planned
Parenthood — the Department of Health and Human Services issued a last minute regulation that will undermine health care access at nearly 600,000 pharmacies, clinics, and hospitals across the country.

This sort of "take the drapes on your way out" approach is the final
chapter of an administration that has prized political ideology over
health care for their entire eight years — and the rule issued
yesterday, with little more than 30 days left in office, is the
ultimate holiday gift to the extreme right.

Under this new rule, doctors and health care workers of all kinds
can deny patients vital health care information and services, without
the patient even knowing. No patient is exempt from the reach of this
rule: sexual assault victims could be denied information about
emergency contraception that could prevent unintended pregnancy, moms
hoping to time their pregnancies can be denied contraception at their
local pharmacy, young adults hoping to be tested for sexually
transmitted infections could be denied treatment by health care
employees who oppose premarital sex.

In short, this rule is likely to create total chaos in an already
stressed health care system, and for low-income women and families,
this rule may spell the end of the few available health care options.
Essentially, any patient that utilizes health care at a provider that
receives any federal funds will be subject to the luck of the draw in
terms of what kinds of reproductive health care they are offered. This
might seem far-fetched, until you realize that groups like Pharmacists
for Life have campaigned nationally to have pharmacies refuse to
provide women birth control prescribed by their physician.

If you had any doubt that this rule is about politics, not health
care, just watch the high-fives among the far right. "This is a huge
victory for religious freedom and the First Amendment," said Tony
Perkins, president of the Family Research Council.

The bottom line in health care has always been that patients’ health
comes first; this regulation turns that basic tenet on its head. In
fact, they failed to address the basic questions of patients’ rights
lodged by hundreds of thousands of Americans during that period.

For months, Planned Parenthood has spoken out against the proposed
regulation. When a draft version of the rule was leaked last summer, we
were the first out of the gate to point out the damage this regulation
could do to women’s health care. And, in the days and weeks to come, we
will work with the new administration and Congress to overturn this
disastrous rule. Our goal has always been to expand — not limit —
patients’ access to full health care information and services. If you
want to help, please sign our petition.

]]>http://rhrealitycheck.org/article/2008/12/19/bushs-parting-shot-undermines-health-care/feed/7HHS Provider Conscience Rule: You Better Shop Aroundhttp://rhrealitycheck.org/article/2008/12/18/hhs-provider-conscience-rule-you-better-shop-around/?utm_source=rss&utm_medium=rss&utm_campaign=hhs-provider-conscience-rule-you-better-shop-around
http://rhrealitycheck.org/article/2008/12/18/hhs-provider-conscience-rule-you-better-shop-around/#commentsThu, 18 Dec 2008 13:23:08 +0000Today's provider conscience regulations go so far as to put the onus on patients to divine what information and services might be withheld by any given provider, and then shop around to find alternatives.

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Today the Bush Administration put
in place the final piece of its shameful women’s health care legacy
by finalizing ill-conceived provider "conscience" regulations that
could dramatically undermine information and access to reproductive
health care services. Confirming our fears, the final rule spends more
than 70 pages explaining why the Administration is ignoring the avalanche
of comments from the medical, legal, women’s and other communities,
as well as from the EEOC, that urge them, in the interest of public
health, to halt all efforts to move forward on the rule.

Like the proposed rules, today’s
regulations will make it easier for providers to refuse patients vital
health services, and harder for patients to learn more about their health
status and health options – precisely the wrong outcomes for our health
care system. The regulations upend the notion of informed consent and
go so far as to clarify that the onus is on women to somehow divine
what information and services might be withheld by any given provider,
and then shop around to find alternatives.

Moreover, the regulations will
create confusion in crucial situations where the health and well-being
of patients should be the top priority. Current law already allows providers
and institutions to refuse to provide abortion or sterilization services
if doing so clashes with their religious or moral beliefs. Yet, sticking
to utterly unsubstantiated claims that a climate of religious intolerance
is preventing qualified individuals from entering health care professions,
HHS finalized a rule that dramatically expands the ability of health
care workers and institutions to refuse health care services.

These final regulations continue
to leave the term "abortion" undefined – thereby inviting providers
to interpret the term to include birth control. Despite claims to the
contrary, this goes far beyond current law, which already accommodates
providers who do not want to offer reproductive health services because
they have religious or moral objections. It opens the door for
insurance plans, hospitals, doctors, nurses and even administrative
staff to deny women access to contraception. The new rule also claims
that Title VII of the Civil Rights Act, which carefully balances protections
for the religious beliefs of employees with protections that ensure
that patients get access to health care services and information, just
doesn’t apply when it comes to reproductive health. According
to the final rule, provider objections in these instances should be
held to a "higher standard" – one that allows providers a virtually
unfettered ability to refuse services and information without requiring
any balancing of patient needs at all! In fact, providers would
be under no obligation to even inform patients of their objections to
providing certain services. That is, quite simply, wrong.

The good news, of course, is
that in the 2008 elections, Americans said they want leaders who will
work together to reduce unintended pregnancy and end attacks on reproductive
rights. Policymakers – in office now and those coming in this January
– have already signaled their intent to work to reverse this rule.
However, we must be vigilant about ensuring that the sincere efforts
to find common ground on reproductive health issues do not result in
any delays in reversing these regulations in service to the "big lie"
at their center: That the moral beliefs of health care violators
are being violated in any way.

At a time when reproductive
health clinics are woefully under-funded, and women in this country
experience millions of unintended pregnancies each year, the Administration
should have been looking for ways to increase women’s access to the
family planning information and services that can help them avoid unintended
pregnancy. Instead, it has done just the opposite.

In the weeks ahead, we are
urging Americans to contact the incoming Administration and Congress
to urge them to say ‘no’ to these dangerous regulations. There are
multiple legislative and administrative remedies to avoid the harm –
but immediate action is essential. At the top of the list is a request
to President-elect Obama to suspend the enforcement of the rule and
then issue a routine request for comments on rescinding the rule permanently.

"You better shop around"
may work for finding bargains in this holiday season, but it’s an
onerous and unacceptable burden to put on low-income women seeking the
reproductive health care they need.

The administration made almost no substantive changes to the regulation following the period of public comment, says Adam Sonfield, senior public policy associate at the Guttmacher Institute. "The 200,000 comments in opposition to the rule they dismiss," says Sonfield. "They pretend to respond directly to them, but they actually don’t." The only major substantive change the administration made to the rule is to expand the definition of the workforce the rule applies to — for instance, it now includes contractors.

An early, leaked draft version of the regulation specifically
suggested that providers who consider hormonal birth control to be an
abortifacient should not have to prescribe it or refer patients for its
prescription. The regulation relied on arcane, non-medical definitions
of pregnancy to suggest that the belief that pregnancy begins at
fertilization is valid and that, a hormonal contraceptive, which
anti-choicers claim block implantation of a fertilized egg, is
tantamount to abortion. The second, released draft, now published,
does not conflate contraception with abortion, but in its broad scope
nonetheless provides protections for providers who would like to
do just that. "The regulation confirms what we feared," says Marilyn Keefe of the National Partnership for Women & Families. "HHS
refused to allay any of the concerns raised in earlier iterations. Contraception
clearly remains a target."

One of the rule’s more disturbing provisions is the announcement that Title X family planning funding will now be open to grantees who refuse to counsel women on the availability of abortion. Title X has always required that when a woman tests positive for pregnancy, she must be counseled on all of her options, including abortion, and given referrals based on what her expressed interest. The regulations state that Title X funding will be granted "non-discriminatorily" to applicants, including those who refuse to provide counseling and referral for abortion.

Additionally, the rule fails to make clear whether health care centers that do intend to provide unbiased options counseling can even ask potential employees whether they are comfortable
participating in an abortion procedure or counseling a woman about her
options, Roger Evans, director of litigation at Planned Parenthood, acknowledged today.

Moral objection, meanwhile, is not strictly limited to religious belief
— it can mean any personal moral commitment, which is a much broader
protection than "traditional conscience clauses," says Jessica Arons, of the Center for American Progress.

The rule must now be submitted to both the Government Accountability
Office and both houses of Congress. Congress has a period of time to
review the rule (and because of the timing of the rule’s publication,
this period will stretch into the 111th Congress), during which time a
motion to disprove can be introduced. If the motion to disprove is
passed by both houses of Congress and signed by the President, the rule
cannot be enforced or defended in court. Using the Congressional Review Act in this way to invalidate the
regulation, however, would be "controversial," says Matt Madia, of OMB
Watch. A motion to disprove has to see an up-or-down vote; it can’t be
attached to appropriations bills or other must-pass legislation.
"Everyone has to go on record on the issue, and there’s no way to fudge
it," says Madia.

If this avenue fails, Congress
could refuse to appropriate funds for implementation of the rule, or
Congress could pass the legislation introduced by Sens. Hillary Clinton
and Patty Murray that would prohibit HHS from implementing the
regulation.
Finally, the new administration could begin a new round of rule-making, perhaps the most time-consuming option.

]]>Earlier this month,
our country participated in an historic election, as the American people voted
for new leaders and a new direction. In the thrill of this remarkable
moment, however, we cannot forget that the Bush administration is still up to
its old tricks. Unfortunately, until January 20th, 2009, we
are governed by an administration who time and time again puts
ideology ahead of women’s health.

We have to stop the
administration’s last minute attempt to undermine health care for those
who need it most. That’s why Senator Murray and I today introduced
critical legislation to suspend the Bush Administration’s latest ploy to put
ideology before women’s health.

As many of you know,
the rule being proposed by the administration would limit patients’ access to
basic reproductive health care services and information. The Protecting
Patients and Health Care Act would prevent HHS from implementing this
ill-conceived, midnight regulation.

Senator Murray and I
have been speaking out against this rule since July when word of this
regulation first came to light. The rule, as it was then proposed in August by
the Department of Health and Human Services, is a serious threat to patients’
access to information and care.

Then in September,
Senator Murray and I had a very frank conversation with Secretary Leavitt about
how this rule could create a slippery slope leading to patients being denied
access to contraception and other important information or care. However,
despite the important concerns we raised to the Secretary, a recent news report
indicated that HHS is planning to release a final regulation in the coming
days.

I am hopeful that members
of Congress from both sides of the aisle will join in fighting for passage of
this important piece of legislation to protect patients’ rights and health
care. And we join President-Elect Obama, the Equal Employment Opportunity
Commission and hundreds of thousands of concerned Americans who have written to
HHS opposing this unconscionable proposal. I urge Secretary Leavitt
to make his decision on behalf of women’s health. Thank you.

]]>http://rhrealitycheck.org/article/2008/11/20/bush-administrations-latest-ploy-ideology-before-womens-health/feed/18How a Hospital in Wasilla Connects to New HHS Regulationshttp://rhrealitycheck.org/article/2008/10/30/how-a-hospital-wasilla-connects-new-hhs-regulations/?utm_source=rss&utm_medium=rss&utm_campaign=how-a-hospital-wasilla-connects-new-hhs-regulations
http://rhrealitycheck.org/article/2008/10/30/how-a-hospital-wasilla-connects-new-hhs-regulations/#commentsThu, 30 Oct 2008 10:38:57 +0000A fight over provider conscience in Wasilla, Alaska, has repercussions in the current debate over new HHS regulations.

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In a parting gift to President Bush’s religious-right base, the Department of Health and Human Services has proposed new regulations that would grant sweeping rights to health care providers’ senses of conscience, enabling a broad range of professionals engaged in health care provision not only to refuse to provide but to refuse to refer for services that they found morally objectionable. But the proposal fails ever to consider not only the conscience of the patient seeking care, but also of the provider whose conscience directs her to provide care, whether others would refuse it.

Take, for example, Valley Hospital in Wasilla, Alaska. In 1992, a group of representatives from evangelical churches took control of the hospital’s board, and voted to bar doctors from performing abortions at the hospital except to save the woman’s life, in cases of extreme medical necessity, rape, incest, or fetal non-viability. In the New York Times, Dorothy Samuels reports that Dr. Susan Lemagie, then the only physician in Alaska who would perform elective abortions after 12 weeks, sued to overturn the policy. Rather than protecting Dr. Lemagie’s conscience, the hospital’s regulations impeded her ability to exercise her own moral sense. Reports Samuels,

Finally, in 1997, the Alaska Supreme Court ruled 4 to 0 in
Dr. Lemagie’s favor, holding that Valley Hospital was a “quasi public”
institution because it was the only hospital serving the community and
received millions of public dollars. As such, it could not deny a
woman’s “fundamental right” to abortion, which is secured by the broad
right to privacy embedded in the state’s Constitution.

Individual health care providers, however, still had the right to refuse to perform procedures they objected to.

Nonetheless, opponents of abortion rights used the Alaska decision to advocate for a federal law that would extend the right of individual providers to deny care to medical institutions, including HMOs and insurance plans. In 2004, a version of that bill, called the Weldon Amendment, passed. New HHS regulations, says Samuels, are essentially an extension of the Weldon Amendment.

]]>http://rhrealitycheck.org/article/2008/10/30/how-a-hospital-wasilla-connects-new-hhs-regulations/feed/0HHS Regs Would Cover All Religious Convictionshttp://rhrealitycheck.org/article/2008/09/24/hhs-regs-would-cover-all-religious-convictions/?utm_source=rss&utm_medium=rss&utm_campaign=hhs-regs-would-cover-all-religious-convictions
http://rhrealitycheck.org/article/2008/09/24/hhs-regs-would-cover-all-religious-convictions/#commentsWed, 24 Sep 2008 07:00:00 +0000If new HHS regulations are adopted, family planning service providers could be forced to hire people who have moral objections to contraception and would be unable to discipline employees who refuse to provide birth control.

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In a classic Grimm brothers’ fairy
tale, the fisherman’s
wife uses
wishes given to her to gain more riches and greater power, until finally she wishes
to be the ruler of the universe. The fable teaches the consequences
of greed, pride, and it is the ultimate "be careful what you wish
for" allegory.

Reproductive health care advocates and providers have written extensively the last few weeks about proposed HHS "conscience
protection" regulations — the period for public comment ends this Thursday,
September 25.

In Wisconsin,
approximately one-third of all health care organizations are religiously
affiliated and many workers sign a contract promising to follow the United
States Conference of Catholic Bishops Ethical and Religious Directives for Health Care
Services. A July letter from
the bishops to members of Congress eagerly embraced the regulations. But the bishops
may have neglected the fact that many workers in Catholic hospitals
and clinics have moral convictions supporting contraceptive care and
reproductive rights and other health care that the church does not sanction
or permit.

If the regulations are adopted, family
planning service providers, like us, could be forced to hire people who have
moral objections to contraception. We would be unable to discipline
employees who refuse to provide birth control or other services to our patients, central to our
mission. Employees
of sectarian health care institutions would operate under the same protections.

For example, clinic employees might refuse to distribute
abstinence-only materials because they are incomplete, inaccurate, and deny a patient’s
right to informed consent. They might have a moral conviction to explain that
condoms, correctly and consistently used, are a reliable means to prevent unintended
pregnancies, and sexually transmitted infections — including HIV transmission to fetuses.

Catholic hospital employees might feel, as a matter of
conscience, that to deny information about emergency contraception to a victim of rape
is morally wrong or that providing pregnancy options information to a high-risk
patient without discussion of termination as well as adoption is willful
neglect.

Many health professionals in sectarian medical teaching
institutions believe that physicians must be trained in modern contraceptive
methods, sterilization procedures, and how to perform emergency abortions.

Earlier this year, a Colorado
bill, parallel to these regulations, would have prohibited religion-based
hiring discrimination. It was loudly
criticized by Denver
Archbishop Chaput, who said the law would "…greatly hinder
organizations like Catholic Charities from maintaining their mission and
purpose as specifically religious institutions."

The federal regulations proposed
by Secretary Leavitt and supported by the US Conference of Bishops incorporate
moral conviction as well as religious belief and extend to all health
care providers receiving federal funds. Speaking from the point-of-view
of health care providers who understand unintended consequences, here’s
a thought for the bishops and the Bush administration: "Asking for
federal protection for employees who refuse to put patient welfare above
personal belief may be equivalent to the fisherman’s wife wishing
to be the ruler of universe. By asking to rule everything, they
ended up with nothing and there the fairy tale ends."

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As if they haven’t done enough,
the Bush Administration is making one last attempt to undermine women’s
reproductive freedom. The Department of Health and Human Services
(HHS) recently proposed a regulation that it claims will protect federally-funded
healthcare providers from discrimination; but in reality, will further
limit a woman’s ability to obtain health services and increase the
number of providers and institutions allowed to refuse her care.
Low-income women and women of color who rely more on public programs
will ultimately be hit the hardest. Significant percentages of Latinas,
Asia Pacific Islanders and African-American women work in low-wage jobs
that don’t offer benefits and therefore, they lack health insurance
of any kind. Public programs such as Medicaid and Title X fill that
void by covering prenatal, pregnancy-related care and contraceptive
services. The deeply flawed regulation fails to serve the needs
of these patients by erecting new barriers to their obtaining reproductive
healthcare.

Under current law, recipients
of federal money, such as Medicaid and Title X, cannot force medical
professionals to provide a woman abortion or sterilization services
if they object for moral or religious reasons. But the proposed
regulations would expand these laws at the expense of patients in several
ways. For one, startlingly, healthcare providers may now be able
to refuse to provide a woman contraception as well as abortion.
The initial draft of the regulations included a definition of abortion
that was so broad that it included some forms of contraception, such
as birth control pills and IUDs. After a huge public outcry, the
HHS removed that definition, but by raising the issue in the first place,
the department left the door open for healthcare providers to use the
sweeping definition to justify the denial of contraception. Before no
institution would have objected to giving a woman birth control pills
and argued that it is the same as performing an abortion.

Two, under the proposed regulation,
HHS would expand the pool of medical professionals who can deny a woman
services. Not only doctors, but virtually anyone involved–like receptionists,
health insurance claim adjustors, and janitors–would be able to refuse
to perform tasks based on religious or moral beliefs. For example,
a receptionist may be allowed to decline to make an appointment for
a woman who needs a prescription for birth control pills or a nurse
may choose not to sterilize equipment used in an abortion. Such
refusals will not only disrupt services in health facilities, but could
possibly result in a woman not receiving reproductive care at all.

Finally, the proposed regulation
would allow healthcare professionals to withhold basic information,
including counseling and referrals. This means that healthcare providers
could not only refuse to give information about abortion and contraception
to a woman, but also to refer her to someone who can explain to her
all of her options.

Low-income women and women
of color already face significant hurdles in accessing healthcare including
discrimination, inflexible work schedules, and inadequate childcare
and transportation. If they are turned away from healthcare providers,
they may not have the resources to locate another physician or healthcare
facility and make arrangements for a second time.

HHS was required by law to
include a cost-benefit analysis with the proposed regulation, but its
analysis was cursory and inadequate, ignoring the costs to individual
patients and the severe impact the regulation will have on vulnerable
groups. The department did not even point to a single instance
where current laws have failed to protect healthcare providers’ religious
liberty and yet, that is the problem the new rules are purportedly designed
to solve. The supposed benefits, such as diversity in the workforce
and increasing awareness of protections for health care providers, are
not supported by any evidence. There’s no scientific, statistical
or empirical data showing that the supposed benefits are a likely to
occur if the regulation is adopted.

There is already an imbalance
between rights of conscience and a woman’s right to reproductive health
care in this country, and the regulations will purposefully tip the
balance further away from a woman’s rights. Implementation of
these regulations will only exacerbate the difficulties low income women
face in getting healthcare and allow the denial of vital health information
and services to those who need it most.

The Center for Reproductive
Rights, the National Asian Pacific American Women’s Forum, and the
National Latina Institute for Reproductive Health believe that the regulations
should be rejected outright, and are submitting joint comments to the
HHS, focusing primarily on the impact on low-income women and women
of color. You can read these comments here.